Welcome! We are speaking with Dr. Carlin Vickery from 5th Avenue Millennium Aesthetic Surgery in New York and her patient, and we’re going to talk a little bit about her surgical experience. What made you seek the help of a plastic surgeon?

I went for a mammogram that turned out to have lots of suspicious looking stuff for a lack of a better word, at this point, and I was referred to breast surgeons to discuss possibly a double vasectomy or to see which was the correct path to go down, and I knew I wanted to do reconstruction right away. That was never an option, and I was referred to Dr. Vickery by 2 (two) doctors.

Great, and what was your consultation like?

I was definitely very, very, very nervous. Did I say very nervous? I was very nervous and probably very quiet, I had a pounding headache and I was definitely in fear. I had never had any plastic surgery before but obviously the talk of a vasectomy first was so huge and I had already sort of visited with 2 (two) or 3 (three) you know, top New York City surgeons and it seemed like all systems were go that I should have a double-vasectomy so I went to Dr. Vickery with my husband and my mom to really learn about that side of the whole situation.

And did you feel that you got the information you needed?

Absolutely! I mean, yes, I went in with really no information so it was a huge education for all of us and that’s why my mom and my husband came as well. We asked a lot of questions and I remember, obviously, she gave us a lot of information and showed us photos and I knew.. it’s interesting; I went to 3 (three) surgeons to talk about this removal of all but I only went to 1 (one) plastic surgeon, so I knew that she was the person.

Dr. Vickery, do you remember anything about the consultation at all that comes to mind?

Like a lot of patients that come in, it’s overwhelming, by the time they get to me they’re pretty exhausted. They’ve already been, as she mentioned, the general surgeons and discussed breasteses until their head hurts, and they’re pretty wide-felt; they’re shellshocked and they’re wiped down, and I think what’s difficult about these consultations is you know, they think mine is going to be the easy part, that I’m just going to say “Great, we’ll put you back together and you can go about your business” and it’s going to be a quick discussion. In fact, breast reconstruction is a very lengthy procedure because there are a number of different techniques and it’s very important to me that the patient knows what a vasectomy is and how reconstruction is totally different than implant reconstruction for cosmetic reasons. So I do end up, unfortunately for them, saying, almost apologetically, that I’m going to have to spend a fair amount of time educating them because I think they need to make a good decision for themselves as to what reconstruction technique they’re going to use and that takes time and understanding. You can tell she’s very receptive to information and it makes it easy to go over that. To work with me, I’m fond of saying that, since the reconstructive process is a lengthy process typically, and we’re going to be walking together along the road for awhile but it’s important that we’re a good match and that we really take the time to understand each other so we can get along that path. But breast cancer is just a chapter in someone’s life, and my sense of accomplishment really comes from getting the patient down that path, back to their life and feeling good about their body. But you know, the reality is after the surgery is done, the relationship between the reconstructive surgeon and the patient is much more intense and frequent and lengthy than that with the person who performs the mastectomy; that’s more of an upfront relationship. Would you agree with that?

Absolutely! Definitely, I mean I spent months, hours… I spent a lot of time in your office and that’s definitely true. I mean it’s not to say you don’t see the general surgeon again but you kind of don’t.

They’ve done their job, they’ve removed the breast

right

It’s the plastic surgeons job to replace the breast which is a process

I mean that’s who you go to the follow up for, and there’s months of that. I agree.

What in particular made a good match? We’re talking about the importance of, you know, being a good match if you’re going to walk on this journey.

You know, I do best with patients who want information and want to be a participant in their decision making and are able to understand what the process is. I always feel as if patients are more relaxed if they have knowledge and that was postoperatively, it’s a little overwhelming preoperatively, but postoperatively I try to educate them about the different stages and how they’re going to feel so that I lower their anxiety level, what I call their misery in fact. You know, this is a hard process and they need to know that there are… people who are going to coach them through it and there are different stages of it. If they listen carefully and I spend the time then I find that that goes very smoothly. She went with me through that whole discussion at a time when she had a headache and she was tired and she really probably didn’t want to be doing that then.

Right.

Well what ultimately was the surgical course? What specifically did you wind up doing, Dr. Vickery?

She had a mastectomies and then we reconstructed her initially with tissue expanders and fortunately for my patients the way they come out of the operating room actually looking as though they’re reconstructed in terms of clothes but those expanders act as molds really around which their tissue is able to create a space that will ultimately be implants. Then we do a second stage, which is a much easier surgery, where we just change them out essentially and any adjustments we make we’ll make at that time. And then is the patient needs to have nipples made we do that as a later time; that’s a relatively short procedure, it doesn’t interrupt their life dramatically and finally you put some tattooing in. If patients had nipple bearing surgery then those last 2 (two) parts don’t have to take place.

The biggest surgery is the first surgery and I think what’s hard for the patients hearing this all the time is they are surprised to hear that it’s a process and that it takes a number of months and if patients having chemotherapy actually then it takes even longer because that prolongs the time that we can’t operate on them. They’re presentable, for sure, they go about their life but they don’t really feel as though the whole process of having had a mastectomy is behind them until they get that tattoo and their healing is taking place and they’re doing the things they want to do with their lives. It is a process, so that’s why it’s important that the relationship between the plastic surgeon and the patient be a mutually respectful and comfortable relationship. You know, there are other places where they are much more, they have volume and plastic surgeons come in and they just sort of announce what they’re going to do and then they walk out the door and they leave a PA or a nurse or something to do some of the explaining and they go about their business and you know, I guess there are some patients who that’s okay by them but the patients that find me are ones who do want the more educated and coached through the process and have more of a hands on by the physician as well as the staff involved in the process.

Dr. Vickery, you talked about a misery index. I’m just wondering if you could speak a little bit about your misery index after you had the first surgery. Did you feel any kind of a shift, was it easier for you after you actually went through the procedure?

I would say from when I had the diagnosis to literally the day I booked the surgery, in other words the day I decided and took the step that I was going to do it, I wasn’t just talking about it. That was my, I would say, lowest point. Once I made the decision to do it I was obviously still nervous but believe it or not my banging headache went away and I was just sort of anxious to get it done at that point. The first surgery, by far, is the worst, or the most difficult I should say. But I always say, and I have spoken to so many friends of friends and cousins of sisters and people since, it’s completely doable. I’m a young, active; I always thought I can’t believe I’m in my low 40’s and I’m being diagnosed but I’m actually, if this sounds possible, I’m thrilled that I was in my low 40’s when I was diagnosed. I’m active, I’m fit, I’m healthy, you know, I have no other health issues. It’s very doable to me, and once you get your mind around the fact that this is your situation and this is what you need to do, you have the right doctors and feel comfortable with them, like I said it’s difficult, but it’s completely doable. I would say after the first surgery, every day, literally each day, I would feel significantly better than the day before which is super encouraging and each day you can do a little more physically as well. Very quickly you see improvement, which obviously works well with your mind. Moving forward, I definitely was tired for a long time but I also have 3 (three) little kids; I couldn’t just stay in bed all day long and I really didn’t want to. I wanted to, I guess prove to myself that I could get up and around and also to my kids.

Right, interesting. And the follow up surgeries, how did that process go?

It went, I think extremely well. They seemed easy breezy in comparison to the first one. I would say the first one is the worst one, which is good that it goes in that direction.

I like that term, easy breezy. I’ll have to remember that.

It gets easier, in other words it’s a better trajectory than the other one. It’s like, it’s so hard, it’s so hard and then it’s kind of not so hard and I almost looked forward to the next procedure because it’s one step closer to closing the door on the chapter like Dr. Vickery said. After the first surgery also, I can remember now, someone came into my room, I don’t know if it was staff of Mount Sinai psychologist or psychiatrist or something, and they said “How are you feeling,” and the truth is, it’s so profound, I felt like I saved my life, I didn’t feel sad. I felt overly happy if that makes sense, even though I was on pain medicine and not comfortable, I really felt like I did the craziest thing for myself. Like how many people can say that they’ve done that?

Right, like you advocated for your own health.

Yes, and luckily I felt so much love from family and friends and doctors and really acquaintances even, like old friends who heard I had surgery called me or sent me something. I actually felt like, this sounds silly but just like “I am woman, hear me roar.” You know, a woman can do anything. I remember saying that to my mom in the room, I felt so good even though I was obviously uncomfortable and in pain.

So it sounds like having to draw from so much courage to advocate for yourself in this way for your own health empowered you.

Completely, and still to this day does. It’s like, if I’m in a situation that’s bothering me I think “oh I can handle this” or “look what I’ve already overcame.”

On that note, it’s the odd silver lining, you know, I wouldn’t wish this surgery on anybody but it’s enormously empowering for patients. They realize the strength of what they can do and then other problems in life or other things which might be jostling, and they simply fade away. In my practice I’ve seen that over 30 years, over and over and over again.

It almost gave me a different confidence. I’m a big believer in good things come from bad things so I just try to look at it that way. This is the kind of situation where it’s unbelievable like… women call each other or strangers or friends of friends and say… Like now I get phone calls, they say my friend was just diagnosed, could you talk to her, tell her your experience, what do you think, you know, so I think wow if I’ve helped one person today then I think it was worth it.

Can you tell me about your final result, after all the surgeries, how you felt about the surgical results?

Thrilled! It probably looks better than what it did even before I had 3 (three) kids, so clearly I couldn’t be happier. I love the way it looks.

It is ironic that in, I can’t say 100% of cases, but in many many cases, particularly women who have had children, that they now have more youthful looking breasts, assuming that there aren’t any complications, radiation sometimes makes that more complicated but she had the ideal circumstances that she hadn’t had multiple surgeries, beforehand she hadn’t had radiation which can interfere with the blood supply, she’s young, so as a result as a plastic surgeon you are able, with the new techniques that we have in utilizing both the new implants and also something called alloderm, which is an inmatrix, that you are able to deliver much more consistent results. And I think that’s one of the things in which over the 30 years I’ve been in practice, is infinitely more satisfying to patients that if they’re facing this that I know I can get them a much better result than I could have 30 years ago. That isn’t to say that they don’t have to go through the journey, I’m not trying to address that one should go doing mastectomies willy nilly on people but, and it’s not perfect, nothing we do is perfect, I’m very aware of that every day, on the other hand I think that she’s able to feel great and her breasts, you know, she’s not the first patient to say ‘gee my friends are jealous I had a bilateral mastectomy’ so they’re looking at me and saying ‘golly, you look better than I do.’ Is that a fair comment?

That’s definitely fair; my one friend says it to me all the time. Yes, lots of compliments.

Thank you so much for coming into this podcast and thank you Dr. Vickery
and cheers to good health!